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• Behavioral Concerns and Problems in Children
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Children and adolescents may engage in occasional physical confrontations, but most do not develop a sustained pattern of violent behavior or engage in violent crime. Those who become violent before puberty may be at higher risk of committing crimes.

Violent behavior is increasingly common among children and adolescents. Almost 10% of students in middle or junior high school and high school report being victims of bullying. In 2005, almost 16% of high school students in the US reported carrying a weapon at least once during the month before they were surveyed as part of a study on youth risks.

Despite growing interest in the possibility of a relationship between violent behavior and genetic defects or chromosomal anomalies, there is minimal evidence for such a relationship. However, several risk factors have been associated with violent behavior, including

• Violent discipline
• Alcohol and drug abuse
• Gang involvement
• Developmental issues
• Poverty
• Access to firearms

There seems to be a relationship between violence and access to firearms, exposure to violence through media, and exposure to child abuse and domestic violence. Children who are bullied may reach a breaking point, at which time they strike back with potentially dangerous or catastrophic results.

Bullying: Bullying is intentional infliction of psychologic or physical damage on less powerful children. Bullying can take several forms, including

• Persistent teasing
• Threats
• Intimidation
• Harassment
• Violent assaults

Cyber-bullying: This is a newly described form in which bullies use e-mail and instant messaging to convey threats. Bullies act to inflate their sense of self-worth. Bullies often report that bullying creates feelings of power and control. Both bullies and their victims are at risk of poor outcomes. Victims often tell no one about being bullied due to feelings of helplessness, shame, and fear of retaliation. Victims are at risk of physical injury, poor self-esteem, anxiety, depression, and school absence. Bullies are more likely to be incarcerated; they are less likely to remain in school, be employed, or have stable relationships as adults.

Gang involvement: Participation in gangs has been linked with violent behavior. Youth gangs are self-formed associations of ≥ 3 members, typically ages 13 to 24. Gangs usually adopt a name and identifying symbols, such as a particular style of clothing, the use of certain hand signs, or graffiti. Some gangs require prospective members to perform random acts of violence before membership is granted. Increasing youth gang violence has been blamed at least in part on gang involvement in drug distribution and drug use, particularly methamphetamines and heroin. Use of firearms is a frequent feature of gang violence.

Prevention

Violence prevention should begin in early childhood. Strategies include

• Violence-free discipline in young children
• Limiting access to weapons and exposure to violence through media and video games
• Creating and maintaining a safe school environment for school-age children
• Encouraging victims to discuss problems with parents, school authorities, and their doctor
• Teaching older children and adolescents strategies for avoiding high-risk situations (eg, places or settings where others have weapons or are using alcohol or drugs) and for reacting to or defusing tense situations

Last full review/revision March 2009 by Stephen Brian Sulkes, MD

Content last modified March 2009